Abstract
BackgroundNonoperative management for blunt splenic injury is the preferred treatment. To improve the outcome of selective nonoperative therapy, the current challenge is to identify factors that predict failure. Little is known about the impact of concomitant injury on outcome. Our study has two goals. First, to determine whether concomitant injury affects the safety of selective nonoperative treatment. Secondly we aimed to identify factors that can predict failure.MethodsFrom our prospective trauma registry we selected all nonoperatively treated adult patients with blunt splenic trauma admitted between 01.01.2000 and 12.21.2013. All concurrent injuries with an AIS ≥ 2 were scored. We grouped and compared patients sustaining solitary splenic injuries and patients with concomitant injuries. To identify specific factors that predict failure we used a multivariable regression analysis.ResultsA total of 79 patients were included. Failure of nonoperative therapy (n = 11) and complications only occurred in patients sustaining concomitant injury. Furthermore, ICU-stay as well as hospitalization time were significantly prolonged in the presence of associated injury (4 versus 13 days,p < 0.05). Mortality was not seen. Multivariable analysis revealed the presence of a femur fracture and higher age as predictors of failure.ConclusionsNonoperative management for hemodynamically normal patients with blunt splenic injury is feasible and safe, even in the presence of concurrent (non-hollow organ) injuries or a contrast blush on CT. However, associated injuries are related to prolonged intensive care unit- and hospital stay, complications, and failure of nonoperative management. Specifically, higher age and the presence of a femur fracture are predictors of failure.
Highlights
Nonoperative management for blunt splenic injury is the preferred treatment
During the study period a total of 79 (64 men and 15 women) hemodynamically stable patients sustaining blunt splenic injury were selected for nonoperative management
The current analysis shows that the presence of a femur injury increases the chance of failure by a factor of 25.9
Summary
Nonoperative management for blunt splenic injury is the preferred treatment. To improve the outcome of selective nonoperative therapy, the current challenge is to identify factors that predict failure. To determine whether concomitant injury affects the safety of selective nonoperative treatment. Splenic injuries were routinely treated by splenectomy. The shift towards nonoperative treatment was initiated by Upadhyaya and Simpson. They were the first to report successful observational management in children in 1968 [8]. Selective nonsurgical treatment of splenic injury can be expected to be successful in over 90% of cases [5, 9,10,11,12,13]
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